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Long Term Functional Results of CMC Joint Arthroplasty with Muscle Interposition and Ligament Reconstruction
Heitor Ulson, MD; Daniel M. Guimaraes; Leila Maria Abdalla, OT, CHT
State University of Campinas - UNICAMP, São Paulo, Brazil

Introduction: To review the long term results of CMC interpositional hemiresection of the trapezium and with the APB muscle and ligament reconstruction.
We present long-term functional results with and technique for treating symptomatic rhizarthrosis , in Eaton & Glickel´s Grades II or III.  In a prospective exploratory study with clinical, surgical and rehabilitation data on 55 patients operated on from 1987 to 2008 who were reviewed for the quality and persistence of results, over a minimum 10-year follow-up.

Methods: The authors employed their technique for surgical treatment of CMC joint osteoarthrosis with muscle as the soft-tissue interposition. The procedure entailed partial trapezium resection, debridement and anteroposterior ligament reconstruction, with a transosseous slip from the APL tendon. Before the new ligament was tightly sutured, the previously dissected origin of the APB with a segment of the digastric tendon inserted therein, was pulled into the new joint space and sutured to the ulnar side of the capsule. The joint was kept pinned with a 1.0 mm K-wire and wrist and thumb were immobilized in a plaster slab.
A 3-month rehabilitation program included heat massaging for edema control. Scar and adhesions were mobilized  and muscle strengthening excercises were stimulated. An abduction orthosis was for night use only.

Functional and radiographic evaluations were performed. The inclusion criteria were Grade II and III, CMC OA patients, undergoing the above procedure and institutional rehabilitation, who agreed to participate in the program. The exclusion criteria were previous surgery of the CMC, important injuries, other rheumatic ailments and refusal to participate.

Twenty-one patients were evaluated (38,3%), and at the time of surgery 20, were 46-76 year-old women and one, was a 66-year old man.  Of the patients lost to follow-up 18 could not be found , 8  had died, 2 claimed disability and 6, refused to participate but delared being satisfied with the operation.
 The average follow-up period from surgery was 15 years (10-22 years). All patients were operated on by the same surgeons at the Hospital Samaritano in São Paulo , Brazil.

Functional Evaluation and Results:
  1. Quick-DASH method average score: 3,12 SD = 4.49 (13.6 - 0.0). Low scores in 81% of the patients.
  2. Hand Strength; pinch gage for both hands, dynamometers for thumb-index, key-pinch and pulp-pinch. Key-pinch = 6.14 kgf, SD 1.24; Pulp-pinch = 4.93 kgf, SD 1.33;
  3. Grind test for elliciting pain: Negative = 20 patients (95%), Positive =1 patient (5%);
  4. Patient satisfaction: Two subjective questions as to satisfaction with the results and if necessary, being operated on the other hand with the same technique. Subjective satisfaction = 20 patients were satisfied and 19, would repeat the operation;
  5. Statistical analysis: with Kolmogorov-Smirnov and paired Student and Wilcoxson Tests when applicable.

Results: Proper ethical precepts were followed both at the time of surgery and of the functional evaluation, by  written informed consent from each patient.

Conclusion: This procedure can restore useful, durable function in a considerable number of satisfied patients.

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